Health Indicator Report of Breast Cancer Screening (Mammography)

Why Is This Important?

Breast cancer is the most commonly occurring cancer in U.S. women (excluding basal and squamous cell skin cancers). It is also the leading cause of female cancer death in Utah. Deaths from breast cancer can be substantially reduced if the tumor is discovered at an early stage. Mammography is currently the best method for detecting cancer early. Clinical trials and observational studies have demonstrated that routine screening with mammography can reduce breast cancer mortality by about 20% for women of average risk.^1^
The U.S. Preventive Services Task Force recommends that women 50-74 years of age undergo mammography every two years, while the American Cancer Society recommends that women aged 40-44 should have the choice to start annual screenings, women 45-54 years old should have annual mammograms, and women 55 and older should have mammograms every other year as long as they are healthy and likely to live for 10 or more years. Women who are at higher than average risk of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and the frequency of that screening.
If you are 40 or over, talk to your doctor about which recommendations are best for you.[[br]]
[[br]]
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''1. Myers ER, Moorman P, Gierisch JM, et al. Benefits and harms of breast cancer screening. JAMA. doi:10.1001/jama.2015.13183.''

Chart

Data Table

Mammogram Within the Past Two Years by Income, Utah, 2014 and 2016

Data Notes

Notes

Age-adjusted to U.S. 2000 standard population.

Data Source

Data Interpretation Issues

To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. In 2010, it began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. More details about these changes can be found at: [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf].
In 2016, age distribution was changed from 8 groupings to 5 groupings; this may affect the interpretation of data trends.

Health Indicator Definition

Definition

The proportion of women 40 years or older who reported having a mammogram in the last two years.

Numerator

The number of women 40 years or older who reported having a mammogram in the last two years.

Denominator

The total number of female survey respondents aged 40 or older excluding those who responded "don't know" or "refused" to the numerator question.

Health Objectives and Targets

Healthy People Objective C-17:

Increase the proportion of women who receive a breast cancer screening based on the most recent guidelinesU.S. Target: 81.1 percentState Target: 76 percent

Other Objectives

CSTE Chronic Disease Indicators

Current Outlook

How Are We Doing?

Between 1989 and 2016, the percentage of Utah women aged 40 or older who reported receiving a mammogram within the last two years increased from 51.6 percent to 65.4 percent.
To reduce bias and more accurately represent population data, the BRFSS changed survey methodology in 2010. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. Based on this methodology, Utah's 2016 rate was 65.4 percent (age-adjusted rate).
All additional indicator views are based on the new methodology.
For 2014 and 2016 combined, there were no significant differences in mammography screening rates between Hispanic and non-Hispanic ethnic groups. Among different races, American Indians had the lowest screening rates at 59.4 percent and Pacific Islanders had the highest screening rates at 76.8 percent.
In 2016, Wasatch County Local Health District (80.2 percent) reported the highest screening rate than the state, while San Juan County Health District (43.3 percent) reported the lowest screening rate in the state.
For Utah Small Areas, the prevalence of mammograms for 2014 and 2016 combined ranged from a high of 90.3 percent in Ivins/Santa Clara to a low of 34.8 percent in San Juan County.
In 2014 and 2016 combined, Utah women 40 to 49 years of age were significantly less likely to have received a mammogram within the past two years (51.2 percent) than older women (74.0 percent among women 50-64 and 71.5 percent among women 65 and over).
In 2014 and 2016 combined, when looking at the highest level of education completed, college graduates were significantly more likely to have received a mammogram (69.3 percent) than women with a high school degree or less (high school graduate, 63.3 percent; below high school, 62.0 percent).
Also in 2014 and 2016 combined, women in households with an annual income of less than $25,000 were significantly less likely to have had a mammogram in the past two years (54.1 percent) compared to those in households earning $50,000 or more (66.5 percent for incomes of $50,000-$75,000 and 73.0 percent for incomes of $75,000 or more).

How Do We Compare With the U.S.?

Nationally, the percentage of women aged 40 or older who reported receiving a mammogram in the past two years increased from 55.2 percent in 1989 to 74.9 percent in 2010. Since 1994, the percentage of Utah women aged 40 or older who reported receiving a mammogram has been below the U.S. rate. In 2016, based on new methodology, 65.4 percent of Utah women aged 40 and older had received a mammogram in the last two years compared with 71.0 percent of U.S. women.

Health Improvement

What Is Being Done?

The Utah Cancer Control Program (UCCP) in the Utah Department of Health (UDOH) provides free breast cancer screening and diagnostics to uninsured or under-insured women 40-64 years old at or below the 250% federal poverty level. Women in need of cancer treatment are enrolled into Medicaid as per the Breast and Cervical Cancer Treatment Act. In addition to providing care to under-served women, the UCCP works with health-systems to implement evidence-based practices to improve cancer screening rates.
In addition, the UCCP initiated the Utah Cancer Action Network (UCAN), a statewide partnership whose goal is to reduce the burden of cancer. The mission of the UCAN is to lower cancer incidence and mortality in Utah through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, testicular, prostate, skin, breast, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, and smoking cessation.

Available Services

The Utah Cancer Control Program (UCCP) provides free to low cost clinical breast exams and mammograms to women who meet age and income guidelines. Eligible women with abnormal screening exams are offered diagnostic evaluation by participating providers. In addition, the UCCP provides education about the need for early detection and the availability of screening services, performs outreach to eligible women, uses an annual reminder system, collects outcome data, and disseminates information about breast cancer. As of July 1, 2001, the UCCP is able to refer Utah women in need of treatment for breast and cervical cancers and precancerous lesions for full Medicaid benefits. The women must meet all requirements as outlined in the National Breast and Cervical Cancer Treatment Act.

Health Program Information

The Utah Cancer Control Program (UCCP) distributes free mammography vouchers to women who receive a clinical breast exam at a UCCP sponsored clinic and meet age and income guidelines. Although the Affordable Care Act (ACA) mandates coverage of screening mammograms, many women are still uninsured or need financial assistance for diagnostic mammograms and other services.

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